Formalization and integration key elements of an effective disability management program for an organization
Too many employee absences can weaken an employer’s foundation, leaving concerns over smooth business operation and a strong and consistent workplace culture. But there are ways employers can minimize the impact of the inevitable bumps in the road caused by absences and modified work that employee disabilities can present — such as effective disability management programs.
According to Statistics Canada, in 2015 unionized full-time employees missed 1.9 times more workdays than their non-unionized counterparts. Public sector employees missed 1.6 times more workdays (12.7) than employees in the private sector (7.8). Women missed more workdays (11.1) than men (7.3). These findings are historically consistent.
In Canada, as women are the major caregivers — a responsibility according to a 2013 study on family caregiving by Turcotte that is associated with psychological and physical illness, and even injury. The Statistics Canada data indicate that women experience more work absence days due to personal or family responsibilities, and when they do get ill or injured, they carry on with their responsibilities, thereby delaying recovery.
Older workers miss more workdays than younger workers. Today, more than 20 per cent of Canadian workers are over 60 years of age. Jan Chappel, senior technical specialist at the Canadian Centre for Occupational Health and Safety, indicates in the September issue of Canadian Occupational Safety that although older workers do not get injured more often, they take longer to recover. As well, the nature of injury differs. Older workers experience more musculoskeletal and time-accumulation injuries along with chronic health conditions; all difficult to rehabilitate resulting in costly absences.
Obtaining relevant fitness-to-work information
Employers, as per Canadian human rights legislation, have a legal duty to inquire about the nature of the employee’s real or perceived disability, along with the related prognosis, expected return-to-work date, and possible residual work limitations. This means a need for suitable communication vehicles, such as a policy on early intervention and case management, a report of absence form, a Job Demands Analysis of the employee’s “own job,” and a Functional Abilities Form. Many employers do not use these tools.
Without the above information, the provision of reasonable accommodation is challenging, if not impossible.
Psychological disabilities
The incidence of psychological disabilities and disorders has increased in our society; the workplace mirrors this occurrence. These costly disabilities ($18,000 per claim as estimated by the Centre for Addictions and Mental Health) are estimated to be twice the price of physical disability situations ($9,000) and more challenging to resolve because of:
• Employees trying to work through a psychological illness/injury.
• The difficulty in getting the right treatment.
• The lack of psychologically safe and healthy workplaces.
• Having employee support services positioned as standalone, “siloed” programs as opposed to being integrated.
Time lags in medical care
Medical time lags are common, especially in rural and remote areas. A related issue occurs when an attending physician conservatively treats the employee’s illness or injury, despite little evidence of recovery. The outcomes are lengthy work absences and delayed return-to-work experiences. Having access to a disability management service provider can facilitate care though the availability of their network of healthcare practitioners. Unfortunately, few employers have arranged for this type of mitigation.
Conflicting medical opinions
Why is this a common occurrence? Healthcare practitioners receive a one-sided viewpoint of the “job” and work environment. Many employers just accept a “medical certificate” as opposed to providing the healthcare practitioner with a Job Demands Analysis of the employee’s job, and requesting that a Functional Abilities Form be completed. Secondly, the right information is often being asked from the wrong healthcare practitioner. Physicians treat and cure, but are limited in their ability to quantify the employee’s physical or psychological capabilities. If seeking that type of information, the Functional Abilities Form should be sent to a physiotherapist, occupational therapist or psychological counsellor. Competent disability management case managers can facilitate employer access to timely and accurate medical information.
Understanding the cost of disability
Only a few Canadian employers know the real cost of disability. Why? According to a 2013 Conference Board of Canada report, just 54 per cent of employers track employee casual absences, and a 2007 survey by Hewitt Associates revealed only 27 per cent track employee disability; a 2011 Towers-Watson survey revealed even fewer employers (22 per cent) use that information to determine the related costs, outcomes and impact. Hence, a small number of Canadian employers use targeted prevention and mitigation strategies to effectively address medical absences.
Vendor risk management
Many employers outsource all or part of their Disability Management Program, without understanding that they retain the related liability and responsibility to accommodate the disabled employee.
Employer opportunities
To turn these challenges into opportunities, the employer must understand the issues, provide leadership, and create a supportive corporate culture and work environment. Upstream action is extremely effective at preventing unwanted downstream consequences:
Adopt a joint labour-management approach to attendance control and disability management. Employers working with their unions can design, implement, evaluate and continuously improve their attendance control and disability management efforts.
Formalize the Disability Management Program (DMP). The “cornerstones” of a Disability Management Program include:
• Early intervention — An employer-initiated response aimed at keeping the ill or injured employee connected to the workplace and preventing medical absence in the first place. Early intervention decreases the number of sick days and increases the likelihood of successful and sustainable return to work.
• Claim management — The administration of income-loss claims through employee benefit insurance plans (short-term disability, workers’ compensation, and long-term disability insurances).
• Case management — The assessment, planning, implementation, co-ordination, monitoring, and evaluation of services available to meet an employee’s health needs. Focusing on competent disability case management greatly improves the organization’s DMP outcomes.
• Return-to-work planning — A “socially fragile process” in which the returning employee, supervisor, and co-workers face the challenge of renegotiating work relationships and duties. Work accommodation must be mutually beneficial; it must meet the employee’s capabilities and the organization’s business needs.
• Return-to-work placement — Ideally, employees should return to their own job — a known position in which they can excel and receive co-worker support. The placement must be monitored to ensure that recovery is realized; an action rarely undertaken by employers.
• Confidentiality — In managing employee personal health information, all individuals are legally required to protect its confidentiality.
• Documentation — For disability claim management, case management, and return-to-work planning and placement, documentation is crucial. It enables monitoring of the employee’s recovery and return-to-work outcome, and demonstrates the organization’s duty to accommodate due diligence.
• Program evaluation and continuous improvement — Data collection and analysis enables the employer to understand the true cost of disability, and identify improvement opportunities.
• Ethical disability management practice — The ethics of the disability situation must be objectively weighed so that the decision-making is rational and based on facts, rather than on emotional issues.
• Legal compliance — Disability management is impacted by law. Stakeholders must be aware that specific acts and regulations change; they should obtain legal counsel to ensure they have the most current case law information when setting up programs or when dealing with specific disability cases.
Create an integrated Disability Management Program. Employers who have created an Integrated Disability Management Program have achieved strong performance outcomes — for example, reduced employee group benefit costs by 15 per cent to 35 per cent. It involves:
• Maximization of organizational resources and expertise — Linking the Human Resources Program, Attendance Control Programs, Disability Management Program, Occupational Health and Safety Program, and Employee Assistance Program into an Integrated Disability Management Program.
• Disability Management practitioner expertise – Position these practitioners to guide, steward and govern the organization to be able to effectively and efficiently control absenteeism and manage disability.
• Competent disability case managers are vital to the successful and sustainable recovery and return-to-work process.
Disability Management Program evaluation
The Disability Management Program has to be regularly evaluated to ensure that it is delivering value. For this to happen, the organization has to establish program goals, objectives, action plans and performance targets, as well as to regularly measure and evaluate their achievement.
Supportive work culture
By creating a supportive work culture that maximizes human performance, management creates a work environment in which safe work practices, a respectful workplace, meaningful employee support, hiring practices that provide good person-job fit, adequate information and equipment, employee education and training, and encouragement to perform at a high level, are the norm.
Case Management assessment
To effectively manage employee illness and injury and diminished functional capacity, a case manager conducts a case management assessment. Hence, the barriers and drivers to a safe and timely return-to-work outcome are identified. Effective case management involves changing barriers into drivers for a successful return to work.
Canadian employers face significant challenges in disability management. Yet, by providing strong leadership and creating a corporate culture focused on establishing an approach to effective absence control and disability management, a solid foundation is created on which to build.
